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THE  AMERICAN  ACADEMY  OF  MEDICINE. 


ANNUAL  ADDRESS  OF  THE  PRESIDENT, 

F^EDE^IC  GEt^ISH,  fl.JVL, 

DELIVERED  AT 


NEW  YORK,  13th  NOVEMBER,  1888. 


\ 


THE 


SPECIAL  FUNCTION 

OF  THE 

AMERICAN  ACADEMY  OF  MEDICINE 


ADDRESS  OF  THE  PRESIDENT, 


DELIVERED  AT  THE 


ANNUAL  MEETING  IN  NEW  YORK, 

13th  NOVEMBER,  1888, 


FREDERIC  HENRY  GERRISH,  A.M.,M.D., 


OP  PORTLAND,  ME. 


PRINTED  BY  ORDER  OF  THE  ACADEMY. 


PHILADELPHIA  : 

1889. 


“The  American  Academy  of  Medicine  is  not 

RESPONSIBLE  FOR  THE  SENTIMENTS  EXPRESSED  IN 
ANY  ADDRESS  OR  PAPER  READ  AT  ITS  MEETINGS.” 


THE 


SPECIAL  FUNCTION  OF  THE  AMERICAN 
ACADEMY  OF  MEDICINE. 


ADDRESS  OF  THE  PRESIDENT, 

Delivered  at  the  Animal  Meeting  in  New  York,  13th  November,  1888. 


BY  FREDERIC  HENRY  GERRISH,  A.M.,  M.D., 

OF  PORTLAND,  ME. 

There  would  seem  to  be  no  need  of  argument  to  persuade  any 
reasonable  person  of  the  necessity  of  something  better  than  a mere 
grammar-school  education  as  a preparation  for  the  study  of  the 
science  and  art  of  medicine.  One  is  not  trusted  to  weigh  our  coal, 
to  measure  our  fire-wood,  to  keep  account  of  the  provisions  which 
we  buy,  without  at  least  as  much  intellectual  training  as  this;  how 
much  more  ample  should  be  the  mental  discipline  of  him  who 
aspires  to  give  us  rules  for  the  preservation  of  health,  and  to  restore 
it,  when  disease  has  prostrated  us  ! And  yet,  instead  of  there  being 
no  necessity  for  argument,  it  is  a lamentable  and  astonishing  fact 
that  very  many  persons,  who  are  generally  considered  rational 
beings,  require  prolonged  and  powerful  argumentation  before  they 
will  accept  this  truth,  which  ought  to  be  almost  axiomatic ; and  the 
great  majority  cannot  be  persuaded  by  any  means  whatever.  The 
medical  opinions  of  the  highly  cultured  and  the  densely  ignorant 
are  strongly  tinctured  with  superstition.  The  great  unwashed  think 
to  ward  off  disease  by  means  of  amulets  and  the  burning  of  tapers, 
to  cure  it  with  consecrated  water  and  incantations ; the  people  at 

3 


4 


the  other  end  of  the  social  scale  are  the  chief  patrons  of  the  latest 
therapeutical  lunacy,  which  proclaims  that  knowledge  of  anatomy 
and  physiology  is  not  only  useless,  but  is  positively  injurious.  Those 
who  know  that  they  would  court  well-merited  ridicule  by  putting 
their  disordered  watches  for  repair  into  the  hands  of  a mechanic 
who  had  not  devoted  years  to  the  careful  observation  and  practical 
management  of  these  comparatively  simple  machines,  will  intrust 
the  cure  of  their  bodies,  the  most  wonderfully  intricate  mechanisms 
known,  to  creatures  who  boast  of  their  absolute  ignorance,  and 
blasphemously  lay  claim  to  powers  which  no  human  being  can 
possess.  It  seems  hopeless,  therefore,  in  this  generation,  to  attempt 
to  convince  the  people  that  medicine  should  be  regarded  as  a science, 
to  be  mastered  only  by  prolonged  application,  and  that,  before 
entering  upon  its  technical  study,  one  should  have  had  a prelimi- 
nary course,  designed  to  prepare  the  mind  to  grasp  and  appreciate 
its  facts,  its  theories,  and  its  methods. 

THE  MEDICAL  PROFESSION  INDIFFERENT  TO  PRELIMINARY 
EDUCATION. 

There  is  one  class  of  men,  however,  to  whom  the  amazed  and 
dejected  observer  of  the  attitude  of  the  public  will  turn  with  full 
confidence  that  from  them  he  will  derive  cheer  and  encouragement. 
The  medical  profession,  composed  of  men  who  have  received  the 
doctorate  from  institutions  of  repute,  will,  he  is  certain,  declare  with 
prompt  and  cordial  unanimity  that,  before  entering  upon  his  pro- 
fessional pupilage,  every  student  of  medicine  must  have  an  amount 
and  kind  of  schooling  which  will  fit  him  to  acquire  his  technical 
education.  They  have  opportunities  to  know,  better  than  any  other 
class,  the  sad  results  of  ignorance  in  physicians;  and,  consequently, 
he  thinks  no  one  of  them  will  do  aught  to  favor  the  project  of  a 
man  who  designs  to  begin  medical  study  with  inadequate  equip- 
ment. He  entertains  an  idea  that  something  approaching  a liberal 
education  ought  to  be  required  ; but,  of  course,  the  least  demanded 
of  the  applicant  will  be  a competent  knowledge  of  his  mother  tongue, 
the  ability  to  write  clearly  and  to  solve  ordinary  arithmetical  and 
algebraic  problems  with  accuracy,  a familiarity  with  the  outlines  of 
political  and  physical  geography,  an  acquaintance  with  the  elements 
of  Latin,  upon  which  the  nomenclature  of  medicine  is  so  largely 
based,  and  with  the  fundamental  facts  and  principles  of  natural 


5 


philosophy,  without  which  physiology  is  an  impenetrable  mystery. 
How  dumbfounded  will  be  this  innocent  seeker  after  truth,  when  he 
learns,  as  inevitably  he  must,  that  a very  large  proportion  of  physi- 
cians, who  possess  respectable  diplomas,  consider  this  minimum 
preparation  in  large  part  unnecessary;  well  enough,  but  far  from 
essential  to  practical  men,  such  as  they  are  proud  to  esteem  them- 
selves ! And  they  live  up  to  their  expressed  belief.  A youth  well 
advanced  in  his  teens  applies  to  the  typical  physician  of  this  sort 
for  admission  to  his  office  as  a student  of  medicine.  The  young- 
ster, we  will  suppose,  has  been  brought  up  on  a farm,  has  had  a few 
winter  terms  of  schooling,  can  read  and  spell  indifferently,  cipher 
a little,  and  achieve  a cramped  chirography  with  laborious  exertion 
of  the  muscles  of  his  right  upper  limb  and  his  face.  The  precep- 
tor takes  the  accomplishments  for  granted,  and,  if  the  boy  has  the 
reputation  of  honesty,  without  question  admits  him  as  his  student. 

THE  INSUFFICIENT  EQUIPMENT  OF  MOST  MEDICAL  STUDENTS. 

It  is  unimportant  here  to  dwell  upon  the  career  of  the  youth 
during  his  professional  pupilage;  the  incompleteness,  the  utter 
inadequacy  of  his  equipment  for  the  study  of  medicine  is  the  feature 
demanding  our  present  contemplation. 

He  immediately  discovers  that  his  reading  leads  him  into  a region 
whose  inhabitants  speak  a language  of  which  he  knows  practically 
nothing.  Untrained  in  intellectual  processes,  he  either  never  dis- 
covers the  only  true  method  of  learning  the  new  tongue,  or  indo- 
lently decides  that  he  can  absorb  all  that  he  needs  by  association 
with  physicians  and  by  reading  books.  The  dictionary,  which 
should  be  the  constant  companion  of  every  student,  particularly 
during  his  first  year  of  medical  life,  lies  neglected,  or,  perhaps,  is 
never  purchased;  and  the  novice  flounders  about  in  his  desultory 
course,  splashing  up  technical  terms  as  recklessly  as  if  their  only 
use  were  to  impress  the  ignorant  with  the  idea  of  the  learning  of  a 
man,  who  can  utter  these  ponderous  words  so  glibly.  It  is  this  kind 
of  physician,  who  always  employs  “pulse”  as  a plural,  of  which  the 
singular  is  “pult;”  who  drops  the  final  letter  from  “forcep,”  when  he 
means  one  instrument  of  the  kind ; who  discourses  with  such  apparent 
erudition  over  the  most  trivial  malady,  that  his  patient  marvels  at  the 
skill  of  the  doctor  who  has  quickly  restored  him  to  health,  even 
though  “ all  his  Latin  parts  were  diseased.”  Very  many  of  our 


6 


Fellows  are  professional  teachers,  and  know  from  much  observation 
that  a slovenly  conception  of  language  by  students — most  conclusive 
evidence  of  a haphazard  style  of  thinking — is  a chief  obstacle  in 
the  work  of  instruction.  Having  no  habits  of  study,  the  pupil 
struggles  along  in  an  unmethodical  way,  and,  consequently,  wastes 
much  of  his  time,  even  though  he  is  industrious.  From  lack  of 
logical  training,  he  fails  to  follow  the  course  of  reasoning  in  many 
of  the  books  which  he  reads,  and  gets  perverted  notions  of  important 
truths.  Ignorance  of  the  branches  which  are  the  proper  prelude 
to  medical  study  continually  obstructs  his  progress,  and  at  frequent 
intervals  he  is  obliged  to  leave  great  gaps  unbridged,  for  lack  of 
material  to  span  them.  When  he  finally  obtains  a diploma,  as  he 
readily  can,  containing  so  extravagant  a certification  of  his  intel- 
lectual and  moral  worth,  that,  if  he  could  translate  it,  even  his 
exuberant  conceit  would  blush  at  the  untruthfulness  of  the  recital, 
he  enters  upon  his  career  of  imposing  upon  a credulous  public,  and 
bringing  legitimate  medicine  into  undeserved  disrepute. 

Doubtless  this  description  will  appear  to  many  minds  as  a gross  bur- 
lesque, an  intemperate  and  exaggerated  account  of  a blemish  in  the 
body  medical,  infrequently  seen  and  of  trivial  moment.  But,  unhap- 
pily, the  story  is  entirely  true.  The  public  demands  no  education 
in  those  from  whom  it  seeks  medical  advice ; and  the  profession 
itself,  by  which  is  meaut  the  great  body  of  physicians,  who  are  deco- 
rated with  the  degree  of  doctor,  while  insisting  upon  some  technical 
training  iu  those  who  seek  admission  to  it,  is  content  with  a low 
standard  for  this  requirement,  and  considers  the  exaction  of  a pre- 
liminary drill  a matter  of  small  consequence,  to  be  evaded  whenever 
possible.  That  the  methods  of  teaching  in  the  majority  of  our  med- 
ical schools  are  strikingly  faulty,  the  amount  of  instruction  given  far 
below  reasonable  limits,  and  the  attainments  demanded  of  candidates 
for  graduation  wretchedly  insufficient,  are  facts  not  difficult  of  dem- 
onstration, and  peculiarly  within  the  domain  of  discussion  in  this 
society.  But,  at  the  present  moment,  it  is  well  to  concentrate  our 
attention  upon  the  indifference  of  the  profession  in  the  matter  of 
education  preparatory  to  medical  study. 

ATTEMPTS  AT  REFORM  BY  MEDICAL  SOCIETIES. 

The  deficiency  was  long  ago  recognized  by  thoughtful  men,  indeed 
has  always  been  appreciated  in  some  degree ; and  the  dissatisfac- 


7 


tion  of  those  who  saw  clearly  its  lamentable  results  found  frequent 
expression  in  various  channels.  National,  state  and  other  societies 
were  often  addressed  on  the  subject  by  their  presidents  and  orators, 
committees  were  appointed  to  devise  plans  for  reform,  and  resolutions 
were  adopted  generally,  if  not  invariably,  without  dissent.  But  the 
desired  change  did  not  appear.  It  is  not  difficult  to  induce  an  asso- 
ciation to  put  itself  on  record  to  the  effect  that  the  standard  of  pre- 
paratory education  must  and  shall  be  elevated ; it  is  quite  another 
thing  to  persuade  the  individuals  composing  the  organization  to  act 
in  accordance  with  this  declaration.  To  the  greater  number  of  mem- 
bers, the  idea  presented  by  one  or  two  earnest  men  seems  commend- 
able, and  they  vote  with  that  display  of  enthusiasm  which  good- 
natured  people  are  wont  to  show  for  a project  in  which  they  do  not 
feel  themselves  especially  concerned,  and  for  which  they  are  under 
no  obligation  to  make  any  exertion.  The  echoes  of  their  applause 
hardly  die  away  before  they  disperse  to  their  homes,  and  being 
removed  from  the  sustaining  atmosphere  of  the  meeting,  most  of 
them  lapse  into  their  old  slipshod  ways.  Their  behavior  reminds 
one  of  the  riotous  demonstrations  of  delight  of  the  occupants  of  the 
galleries,  when  the  hero  of  the  drama  pronounces  some  virtuous 
platitude.  We  hope  that  they  are  actuated  in  their  daily  lives  by 
the  holy  motives  for  which  they  evince  such  admiration  ; but  we 
have  our  fears  that  their  practical  morals  are  not  blameless.  Few 
men  have  the  hardihood  to  array  themselves  openly  on  the  side  of 
convicted  ignorance,  and  therefore  those  members  who  inwardly  dis- 
sent outwardly  agree;  but  they  wilfully  persist  in  their  vicious 
courses  in  private. 

It  is  well  that  societies  take  such  action.  A main  reason  for  their 
not  effecting  more  is  that  the  intervals  between  their  declarations 
are  too  long,  and  the  impression  made  at  one  time  is  nearly  or  quite 
effaced  before  another  blow  is  struck.  And  so  the  reform  is 
deferred. 

EFFORTS  AT  REFORM  BY  SOME  MEDICAL  SCHOOLS. 

Until  a very  recent  period,  any  male  of  the  human  species,  who 
was  apparently  not  less  than  seventeen  years  old,  who  would  pay 
the  stated  fees,  and  whose  complexion  was  sufficiently  Caucasian, 
found  no  difficulty  in  entering  even  our  most  celebrated  schools. 
Only  females,  children,  the  moneyless  and  negroes  were  excluded. 


8 


Candidates  for  admission  were  not  compelled  to  show  the  possession 
of  the  slightest  knowledge.  A few  years  ago,  a small  number  of 
schools,  after  a prudent  period  of  warning  to  those  who  contem- 
plated medical  study,  established  a preliminary  examination.  Gen- 
erally, no  pretence  of  a high  standard  was  made : a grammar-school 
education  only  was  required.  But,  though  it  was  so  insignificant  an 
exaction,  it  made  a difference  in  the  attendance  which  is  almost 
incredible  to  one  not  entirely  familiar  with  the  attainments  of  the 
average  medical  student.  So  great  was  this  falling  off  that  one  of 
the  largest  schools  in  the  country,  for  many  years  so  prosperous 
that  it  evidently  thought  itself  entirely  secure  in  the  affection  of  the 
profession,  found  its  patronage  shrunken  in  one  year  so  alarmingly 
that  it  beat  a hasty  and  ignoble  retreat  to  its  former  position,  and 
thereafter,  as  previously,  put  a premium  on  incapacity  and  dullness. 
The  executive  officer  of  one  of  these  schools,  which  adhered  to  its 
advanced  professions,  says  that  he  receives  more  letters  of  inquiry 
about  the  examination  than  about  all  other  matters  relating  to  the 
school.  The  number  who  are  rejected  at  the  examination  is  small 
compared  with  that  of  those  who  refrain  from  coming  for  fear  of 
rejection.  And  thus  the  school  has  to  witness  the  growing  material 
prosperity  of  a rival  institution,  which  requires  only  cash  of  appli- 
cants, while  its  own  classes  are  dwindling. 

The  movement  toward  a better  preparation  for  technical  training 
made  little  progress  for  some  time,  when,  all  at  once,  the  circulars 
of  many  schools  burst  forth  with  the  announcement  that  students 
must  demonstrate  their  fitness  for  medical  study.  Had  the  leaven 
been  working  all  these  years,  and  suddenly  displayed  these  effects? 
Had  the  eyes  of  so  many  faculties  simultaneously  been  opened  to 
the  exceeding  sinfulness  of  their  former  practices  ? Perhaps  so ; 
and  yet,  by  a curious  coincidence,  these  advertisements  appeared 
not  long  after  the  Illinois  State  Board  of  Health  proclaimed  that, 
if  schools  wished  their  diplomas  to  be  recognized  in  that  State,  they 
must  have  a preliminary  examination. 

THE  INSINCERITY  OF  MANY  MEDICAL  SCHOOLS  EXPOSED. 

It  is  one  thing  to  profess,  quite  another  thing  to  practice.  It  may 
be  remembered  that,  at  our  last  annual  meeting,  there  were  reported 
the  results  of  an  investigation  of  the  requirements  for  preliminary 
education  in  the  medical  colleges  of  the  United  States.  What  the 


9 


institutions  announced  was  readily  learned  from  Dr.  Rauch’s  elab- 
orate report  ;*  but  to  ascertain  what  they  really  required  was  much 
more  difficult.  It  seemed  necessary  to  adopt  detective  methods,  and 
a little  child,  who  had  but  just  learned  to  write  with  a pen,  was 
the  principal  medium  through  which  the  desired  information  was 
obtained.  Letters  were  written  to  most  of  the  schools,  confessing 
ignorance  of  some  study  which  was  advertised  as  essential  to  admis- 
sion, and  asking  if  that  would  be  an  impediment  to  entrance.  “ If 
a school  declined  to  modify  its  rules  for  such  a correspondent,  there 
would  still  be  no  conclusive  evidence  that  it  might  not  do  so  in  the 
case  of  a person  who  was  exceptionally  prepared  in  other  branches, 
and  lacking  in  a single  one;  but,  if  a school,  publicly  announcing 
that  it  admitted  pupils  only  after  they  had  proved  themselves  edu- 
cated in  certain  lines,  on  such  an  appeal  agreed  to  ignore  an  impor- 
tant branch  of  preparatory  study;  still  more,  if  it  eagerly  besought 
the  patronage  of  this  evidently  unfitted  candidate,  it  may  be  fairly 
claimed  that  the  institution  had  demonstrated  the  hollowness  of  its 
professions  and  the  utter  insincerity  of  its  position.  The  plan 
adopted  cannot  be  regarded  as  a test  of  the  measure  of  virtue  of  a 
school,  but  rather  as  a test  of  its  capacity  for  vice.  The  result  of 
the  investigation  showed  that  about  one-quarter  of  our  medical  col- 
leges make  no  pretence  of  requiring  any  real  preliminary  education 
in  their  pupils  ; a few  hint  vaguely  at  the  desirability  of  some 
knowledge;  and  about  two-thirds  announce  an  examination  or  its 
equivalent,  as  shown  by  a certificate.  Of  these  last  one-half  adhere 
to  their  published  rules,  and  the  other  half  evidently  do  not  mean 
what  they  say  and  stand  detected  in  their  abominable  fraud.  The 
actual  standard  is  extremely  low.  A very  few  schools  require  a 
preliminary  education  which  is  an  approach  to  an  equipment  for 
medical  study ; a considerable  number  insist  upon  a knowledge  of 
the  ordinary  grammar-school  branches,  with  a mere  trifle  of  natural 
philosophy;  the  most  will  admit  any  man  who  can  write  an  intel- 
ligible letter  of  inquiry  and  pay  his  tuition  fee,  however  deficient  he 
may  be  intellectually.”'!' 


* Annual  Report  of  the  Illinois  State  Board  of  Health, 
f Extract  from  my  report,  presented  at  the  Washington  meeting  of  the 
Academy,  3d  September,  1887. 

As  this  report  has  not  been  published,  it  is  pertinent  to  insert  in  this  place 


10 


v 

It  would  appear  that  the  Illinois  law  has  done  much  to  stimulate 
the  timid  and  reluctant  schools  to  activity  in  a desirable  direction ; 
but  it  is  evident  that  law  alone  will  not  accomplish  all  that  is 
needed.  Some  will  obey  through  fear ; others  will  be  set  thinking 
as  never  before,  and  will  acquiesce  with  the  grace  which  waits  on 
judgment;  and  others  still  will  “keep  the  word  of  promise  to 
the  ear,  and  break  it  to  the  hope.”  No  law  will  succeed  which  is 
not  sustained  by  public  approval.  To  be  sure,  the  existence  of  a 
law  helps  in  creating  a supporting  sentiment,  but  the  major  part  of 
this  work  must  be  done  by  different  means. 

THE  NECESSITY  FOR  A SOCIETY  ON  THE  BASIS  OF  THE 
AMERICAN  ACADEMY. 

Just  here,  it  seems  to  me,  opens  the  field  of  the  Academy.  In 
1876,  the  year  of  its  birth,  when  the  seven  founders  were  assembled 
in  Philadelphia,  Dr.  R.  Lowry  Sibbet  read  a paper  entitled  “ The 
necessity  of  an  organization  which  shall  encourage  a higher  stand- 
ard of'  qualifications  in  the  medical  profession.”  The  keynote 
sounded  that  day  is  ringing  still.  The  other  societies  of  physicians 


some  of  the  answers  received  from  schools  which  made  haste  to  confess  that 
their  public  announcements  were  fraudulent,  and  clamored,  as  it  were,  for 
the  patronage  of  a person  whose  letter  of  inquiry  bristled  with  evidences  of 
illiteracy. 

“ The  examination  is  not  difficult.  No  one  has  as  yet  failed  to  pass.” 
“We  do  not  propose  to  make  our  entrance  examination  a bugbear  to 
applicants.” 

“ Our  preliminary  examination  is  very  simple.  We  don’t  require  much 
philosophy— just  a few  elements.  But  I don’t  think  you  need  worry  about 
that.” 

“You  will  experience  no  difficulty  in  entering.” 

“Natural  philosophy  is  not  required,  but  is  a suggestion  as  to  a line  of 
liberal  education.  You  will  have  no  trouble  in  passing  the  entrance  exami- 
nation.” 

“ You  need  not  worry  over  the  examination.” 

“ You  need  not  be  burdened  by  any  fear  of  the  examination.” 

“The  preliminary  examinations  are  not  difficult  or  technical,  and  no 
deserving  applicant  is  rejected  on  account  of  not  being  able  to  pass  them.” 

“ Never  mind  about  the  natural  philosophy ; that  will  be  all  right.” 

“Call  and  see  me,  when  you  reach  the  city,  and  I will  arrange  matters 
for  you,  so  that  there  will  be  no  trouble.” 


11 


were  established  largely  or  wholly  to  promote  technical  knowledge, 
and  only  incidentally  do  they  touch  the  interests  of  education.  We 
have  seen  how  futile  are  their  spasmodic  attempts  at  improvement 
of  the  quality  and  amount  of  teaching,  how  imperfect  are  the 
results  of  statutes  on  the  subject,  how  essential  it  is  that  the  pro- 
fession itself  should  be  converted  to  the  belief  that  men  who  are  to 
study  medicine  should  have  good  minds,  well  trained  and  richly 
stored.  How  can  this  conversion  be  accomplished  as  speedily,  as 
thoroughly,  or,  I would  almost  say,  at  all,  except  by  means  of  a 
special  society  ? It  is  thus  chiefly  that  men  are  persuaded  in  matters 
of  religion  and  politics.  The  experience  of  ages  has  demonstrated 
that  these  objects  are  not  attained  but  through  the  agency  of  power- 
ful organizations,  which  toil  unceasingly  to  achieve  their  peculiar 
ends.  How  ineffectual  would  be  the  church,  if  it  relaxed  for  a 
moment  its  hold  on  its  votaries,  or  diminished  its  watchfulness  for 
opportunities  to  augment  its  power ! What  utter  defeat  awaits 
the  political  party  which  fails  to  reach  and  constantly  to  impress  the 
remotest  hamlet  with  its  arguments,  and  to  keep  in  hand  the  whole 
body  of  its  constituents!  In  these  familiar  examples  we  have  our 
lesson.  We  have  not  sufficiently  appreciated  the  need  of  incessant 
agitation.  Rarely  is  opinion  changed  by  a single  presentation  of  an 
argument,  however  powerful ; but  repetition  at  short  intervals  finally 
succeeds.  Non  vi,  sed  scope  cadendo.  As  in  the  training  of  animals, 
and  the  education  of  children,  so  is  it  also  in  the  persuasion  of  men 
— line  upon  line,  precept  upon  precept,  here  a little  and  there  a 
little. 

THE  WORK  OF  THE  ACADEMY  STRICTLY  PHILANTHROPIC. 

It  is  evident  that  this  work  is  purely  philanthropic,  and,  conse- 
quently, is  far  less  likely  to  attract  a large  following  than  that  of 
other  medical  societies.  One  may  say  that  their  object,  also,  is  the 
benefit  of  humanity  : that  they  aim  at  the  improvement  of  their 
members  in  medical  science,  and  that  thus  mankind  is  helped  to 
greater  health,  increased  comfort  and  longer  life.  True ; but, 
while  they  are  thus  learning  how  better  to  aid  their  fellow-men, 
they  are  perfecting  themselves  in  the  particular  line  of  work  by 
which  they  get  their  living.  There  is  not  this  double  incentive  to 
labor  in  the  Academy.  Striving  to  elevate  the  standard  of  medical 
education  does  not  make  one  more  skillful  as  a physician  or  surgeon  ; 


12 


on  the  contrary,  it  consumes  time  and  strength  which,  if  given  to 
his  regular  labor,  will  make  him  a better  practitioner  and  a richer. 
Our  cause,  therefore,  calls  for  sacrifice,  for  unselfish  devotion,  for  a 
spirit  which  is  satisfied  only  with  ideal  results,  for  souls  “ alert  with 
noble  discontent,  and  upward  yearnings  of  unstilled  desire.”  And 
doubt  not  that  it  has  them — not  all  in  our  company  at  present,  but 
willing  to  join  us,  and  eager  to  have  a hand  in  the  task. 

But  it  is  doubtless  in  your  thoughts  that  we  should  do  other 
things  than  this;  we  should  investigate  scientific  problems,  and 
report  our  results  at  our  meetings,  proving  by  the  superior  quality 
of  our  contributions  that  a classical  education  has  enabled  us  to 
surpass  others  not  thus  favored,  and,  in  this  way,  to  present  an 
object  lesson  in  support  of  our  main  proposition.  In  this  view  Ido 
not  agree ; not  that  I have  the  slightest  fear  that  the  college-bred 
physician  will  not  justify  the  claims  that  are  made  for  him,  as  man, 
practitioner,  investigator,  author  ; but  because  the  most  conspicuous 
efforts  of  the  Academy  should  be,  according  to  the  original  design, 
in  a purely  educational  direction,  and  it  is  impossible  that,  to  any 
large  extent,  men  who  have  original  scientific  conceptions  will  first 
announce  them  at  our  meetings,  where  there  will  be  at  any  one  time 
so  few  who  are  competent  to  appreciate  the  merits  of  the  new  ideas. 
The  inventor  of  a novel  operation  for  removing  the  uterus,  how- 
ever enthusiastic  a Fellow  of  the  Academy,  will  carry  his  paper 
describing  the  process  to  the  Gynaecological  Society,  where  he  is 
sure  of  a large  company,  capable  of  estimating  its  worth.  The 
neurologist  will  take  his  discovery  to  the  association  of  specialists 
whose  daily  experiences  qualify  them  to  hear  him  with  full  under- 
standing ; and  so  for  all  the  rest,  whether  they  cultivate  limited 
portions  of  the  great  domain  of  medicine,  or  distribute  their  ener- 
gies over  it  all.  In  the  line  of  scientific  work,  we  are  handicapped 
from  the  start ; we  can  offer  no  inducements  which  will,  as  a rule, 
attract  the  best  efforts  of  the  leaders. 

GREAT  INCREASE  OF  FELLOWSHIP  NEEDED. 

The  first  step  in  our  undertaking  is  the  adoption  of  a plan  for 
securing  the  fellowship  of  all  who  are  eligible  under  our  rules,  and 
would  be  creditable  associates.  There  is  an  unpleasant  implication 
in  these  closing  words,  but  it  is  unavoidable.  We  not  only  recog- 
nize the  great  attainments  and  generous  culture  of  many  men  who 


13 


have  never  graduated  at  a college,  but  we  are  compelled  to  admit 
that  many  who  have  received  the  baccalaureate  degree  possess  little 
ability,  and  are  not  entitled  to  respect.  The  lion’s  hide  has  no 
monopoly  in  clothing  the  braying  quadruped ; too  often  we  are  cha- 
grined to  find  that  the  sheepskin  covers  an  ass.  But  the  great 
majority  of  college-bred  physicians  would  be  welcome,  and  ought  to 
be  with  us ; and,  with  proper  effort,  we  can  win  them. 

Three  years  ago,  Dr.  Gihon,  in  his  brilliant  presidential  address, 
after  stating  that  the  Academy  had  but  291  Fellows,  asked:  “Is 
that  much  of  a harvest  after  nine  years’  tilling  ? ” What  tilling, 
pray?  What  large  effort  was  ever  made  to  increase  our  numbers? 
In  my  State  there  has  long  been  a respectable  percentage  of  doctors 
of  medicine,  who  are  also  bachelors  of  arts  and  men  of  deservedly 
good  repute;  but  their  fellowship  had  not  been  sought,  when  our 
good  friend  discouragingly  wrote  his  reasons  “why  this  bantling 
has  not  made  greater  progress,  and  why  it  has  no  reason  to  expect 
it.”  That  these  worthy  men  were  not  indifferent  to  the  purposes  of 
our  society,  and  only  needed  to  be  invited  in  the  right  way  to 
engage  in  the  unselfish  task  which  it  had  set  for  itself,  is  sufficiently 
proven  by  the  fact  that,  while  there  were  but  two  Fellows  in  Maine 
at  that  time,  there  are  forty-one  to-day.  I do  not  believe  that  “ the 
time  has  come  when  every  limitation  to  fellowship  should  be 
removed,  except  the  solitary  requirement  that  the  candidate  shall 
be  in  fact,  as  in  title,  learned  in  medicine,  and  in  all  else  that  that 
implies.”*  Before  we  alter  essentially  the  conditions  of  fellowship, 
we  should  gather  under  our  banner  all  the  eligibles  who  can  be 
enlisted.  Unless  it  is  possible  to  demonstrate  in  this  way  that  most 
college-bred  physicians  are  so  thoroughly  convinced  of  the  useful- 
ness of  their  preparatory  education  that  they  are  interested  in  the 
attempt  to  persuade  others  to  pursue  a like  course,  it  is  not  probable 
that  a large  accession  to  our  numbers  will  be  made  from  among 
those  who  have  had  no  such  privileges  in  their  youth.  Though 
many  of  these  last  mentioned  deeply  deplore  the  meagreness  of  their 
early  schooling,  and  make  many  sacrifices  in  order  to  give  their  sons 
a classical  and  scientific  training,  they  could  not  be  expected  to 
wish  admittance  to  a body  which  was  avoided  by  those  whom  it  was 
organized  to  include. 


Dr.  Gihon’s  presidential  address,  1885. 


14 


There  are  some  physicians,  however,  though  probably  not  many, 
who  would  be  glad  of  an  opportunity  to  enter  the  Academy  on  the 
passage  of  an  examination,  equivalent  to  that  enforced  in  colleges 
conferring  the  degree  of  A.  B.  In  this  connection  a letter,  recently 
received  by  one  of  our  Fellows,  is  of  interest.  The  writer  had  been 
invited  to  apply  for  fellowship,  but  was  obliged  to  decline,  not  being 
a college  graduate.  But  he  expresses  deep  interest  in  the  Academy, 
and  thinks  that  many,  now  debarred,  might  strive  for  fellowship,  if 
it  were  possible  to  prove  on  examination  the  possession  of  such  an 
education  as  the  holding  of  a degree  in  arts  indicates. 

This  suggestion,  which  comes  from  a gentleman  of  culture  “ whose 
influence,”  as  the  Fellow,  who  hoped  to  be  able  to  recommend  his 
election,  remarks,  “ would  be  most  useful  to  the  Academy,”  might 
be  adopted  without  the  least  danger  of  lowering  the  grade  of  require- 
ments ; and  it  is  not  impossible  that,  in  the  future,  when  fellowship 
in  our  society  has  become  a greater  honor  than  at  present,  and  is 
sought  with  anxious  eagerness,  the  certificate  of  the  Academy  that 
such  an  examination  has  been  passed  with  credit  will  be  everywhere 
regarded  as  equal  to  a baccalaureate  diploma. 

A PLAN  TO  AUGMENT  THE  FELLOWSHIP. 

Entertaining  the  views  which  have  just  been  expressed,  in  disa- 
greement with  those  pronounced  here  three  years  ago,  I hoped  to 
demonstrate  in  my  administration  the  correctness  of  my  position. 
It  seemed  to  me  that  the  Academy  had  a right  to  expect  to  make 
greater  progress,  even  in  this  matter  of  numbers;  and,  therefore,  a 
plan  was  formed  to  test  the  question.  To  a number  of  my  medical 
friends  was  sent  the  following  circular,  in  which  it  will  be  observed, 
no  hope  of  personal  advantage  is  held  out  as  an  inducement,  no 
opportunity  to  gratify  a taste  for  display  is  hinted  at,  no  benefit  to 
one’s  self  is  even  implied,  save  the  satisfaction  which  must  come 
from  the  performance  of  duty ; and  with  the  circular  were  enclosed 
a blank  for  application  and  a brief  letter,  inviting  to  fellowship  and 
asking  permission  to  stand  as  sponsor. 

THE  CIRCULAR, 

“The  American  Academy  op  Medicine,  founded  in  1S76,  is  a society  composed  of 
physicians  of  at  least  three  years’  experience  in  practice,  who,  previously  to  gradua- 
tion in  medicine,  received  the  degree  of  bachelor  or  master  of  arts,  after  a regular 
collegiate  course.  Its  purpose  is  not  to  establish  an  aristocracy  in  the  medical  pro- 


15 


fession,  but  to  advance  the  standard  of  requirements  preliminary  to  technical  study, 
to  elevate  medical  education  to  a plane  far  above  that  which  it  now  occupies,  and,  by 
other  similar  means,  to  promote  the  welfare  of  the  profession. 

“Already  the  purely  scientific  interests  of  medicine  are  provided  for,  as  far  as  soci- 
eties can  further  the  cause,  by  organizations  devoted  to  the  development  of  the  various 
specialties ; but  no  other  association  has  concentrated  its  attention  on  the  field  which 
the  Academy  was  established  to  cultivate.  It  is  believed  that  its  purposes  only  need 
to  be  stated  in  order  to  arouse  the  hearty  sympathy  of  those  physicians  whose  pre- 
paratory studies  and  honorable  standing  make  them  eligible  to  its  fellowship.  The 
necessity  for  the  work  which  the  Academy  is  equipped  to  perform  is  too  obvious  to 
require  demonstration,  and  it  is  in  the  highest  degree  desirable  that  every  qualified 
physician  should  participate  in  this  labor,  not  simply  by  using  his  individual  efforts 
to  influence  those  with  whom  he  comes  personally  in  contact,  but  also  by  uniting  with 
those  of  his  professional  brethren  who  entertain  the  same  opinions  and  are  actu- 
ated by  the  same  high  motives.  Only  by  the  combined  and  persistent  endeavors  of 
such  men  can  medical  education  in  this  country  be  made  what  it  ought  to  be,  and 
this  task  is  of  the  nature  of  an  obligation,  which  the  nobility  of  culture  imposes  upon 
all  who  bear  its  insignia. 

“ It  is  earnestly  hoped  that  each  physician  who  receives  this  circular  will  display 
his  willingness  to  share  in  this  great  undertaking  by  entering  the  Academy  at  an 
early  date. 

“ A blank  application  for  fellowship  is  enclosed  herewith.” 


The  replies  came  so  promptly  and  were  so  cordial  that  it  seemed 
wise  to  propose  the  plan  to  my  associates  ; for,  if  it  was  efficacious 
in  the  hands  of  one,  why  should  it  not  prosper  with  all?  Con- 
sequently, to  nearly  every  Fellow  was  sent  the  following  circular 
letter,  with  three  of  the  explanatory  leaves,  three  blank  applications, 
a list  of  the  Fellows  in  this  State,  a stamped  envelope  directed  to 
myself  for  reply,  and  a personal  autograph  letter  asking  his  aid  : — 


American  Academy  of  Medicine.  Portland,  Maine,  August,  1S8S. 

Dr 

Dear  Sir:  The  principal  need  of  the  Academy  at  present  is  a large  membership. 
It  is  of  the  highest  importance  that,  practically,  all  of  the  college-bred  physicians  in 
the  United  States  should  be  entered  on  its  rolls.  To  a great  extent  this  result  can  be 
accomplished  speedily  through  the  efforts  of  the  present  Fellows,  and  only  thus. 
Experience  has  demonstrated  that  few  apply  for  membership  without  being  invited ; 
but  it  has  also  shown  that,  with  proper  urging,  it  is  not  difficult  to  induce  men  to  join 
our  ranks. 

Heretofore  no  systematic  attempt  has  been  made  to  increase  our  fellowship ; but 
such  a measure  is  now  projected,  and  in  it  I beg  to  ask  your  earnest  cooperation. 

There  are,  doubtless,  in  your  neighborhood  (city,  county,  State),  or,  at  all  events, 
among  your  acquaintances,  some,  I trust  many,  who  will  be  induced  by  your  personal 
persuasion  to  apply  for  admission.  The  method  which  has  proved  most  successful  is  for 
the  Fellow  to  write  an  autograph  letter,  stating  the  case,  offering  to  stand  as  sponsor 


1G 


requesting  an  early  reply,  and  enclosing  a blank  for  application,  a circular  setting 
forth  the  objects  of  the  Academy,  and  a stamped  envelope  for  the  answer.  If  a response 
does  not  arrive  in  a fortnight,  a second  letter,  calling  attention  to  the  first,  is  desirable. 
When  the  applications  are  received,  the  Fellow  should  sign  the  recommendation,  and 
forward  the  papers  to  the  president. 

Three  circulars  and  three  blanks  are  enclosed  herewith,  and  it  will  afford  me  much 
pleasure  to  supply  you  with  as  many  more  as  you  shall  request. 

The  service  which  the  Academy  asks  of  you  calls  for  the  writing  of  a number  of  let- 
ters and  the  expenditure  of  some  valuable  time  in  the  search  for  suitable  candidates; 
but,  certainly,  it  is  not  greater  than  any  Fellow  is  more  than  willing  to  devote  to  the 
cause  in  which  he  enlisted  by  entering  the  Academy. 

If  every  Fellow  will  do  what  he  can  to  awaken  the  interest  of  his  friends,  our  num- 
bers will  be  immediately  so  augmented  as  to  make  the  Academy  a most  powerful  and 
honored  organization,  and  enable  it  to  contribute  in  a hitherto  unexampled  manner 
to  the  accomplishment  of  the  reforms  which  it  was  instituted  to  promote. 

Hoping  for  your  support  and  encouragement  in  this  work,  and  awaiting  your  reply 
with  eagerness,  I am,  Respectfully  yours, 

Frederic  Henry  Gerrish,  President. 

I am  obliged  to  confess  that  the  result  has  fallen  far  short  of  what 
seemed  moderate  anticipation.  That  most  of  the  letters  were  deliv- 
ered would  seem  to  be  sufficiently  attested  by  the  return  of  only  one 
as  uncalled  for.  Less  than  half  were  answered  in  any  way,  though 
a second  circular  letter,  requesting  attention  to  the  first,  was  sent  to 
all  who  had  not  replied.  Forty-five  applications  were  gathered  by 
twenty  six  Fellows,  in  addition  to  fifty-three,  which  were  secured 
by  one  other;  so  that  we  add  ninety-eight  to  our  membership — 
more  than  in  any  two  years  previously.  Probably  this  does  not 
represent  the  entire  product  of  the  scheme : some  have  reported 
themselves  as  expecting  to  procure  applications,  and  these  will  swell 
the  list  of  next  year.  My  hope  was  to  double  our  numbers;  for  I 
thought  that  there  could  be  few  Fellows  who  had  not  among  their 
acquaintances  some  who  were  eligible  and  would  accept  an  invitation 
to  fellowship.  When  one  Fellow  can  obtain,  without  difficulty, 
more  than  fifty  applications — a number  exceeding  the  entire  admis- 
sions in  any  former  year — it  is  not  reasonable  to  suppose  that,  the 
other  three  hundred  cannot  procure  an  average  of  one  apiece  with 
slight  exertion. 

The  causes  of  so  small  a return  for  the  prolonged  and  irksome 
toil  which  it  cost  are  doubtless,  first,  the  fact  that  the  vitality  of  the 
Academy  was  almost  suspended  during  the  year  immediately  pre- 
ceding: it  was  proposed  to  omit  the  annual  meeting,  and,  when  held, 
it  was  almost  spiritless ; the  papers  were  few,  hardly  enough  addi- 


17 


tions  were  made  to  compensate  for  the  mortality  subtractions,  and 
nobody  could  have  felt  otherwise  than  depressed  at  the  dismal  per- 
formance. It  takes  time  aud  powerful  effort  to  regain  so  much  lost 
ground;  and  it  is  to  be  hoped  that  the  Fellows  will  never  again 
allow  themselves  to  be  deluded  with  the  notion  that  any  society  will 
progress,  or  even  keep  alive,  without  the  devoted  care  and  constant 
activity  of  its  members.  Health  and  vigor  cannot  be  looked  for  in 
the  prolonged  absence  of  nourishment  and  exercise — a commonplace 
which  ought  not  to  be  required  in  an  assemblage  of  physiologists. 
Second,  it  is  unquestionably  true  of  our  association,  as  of  every  other 
of  which  I have  knowledge,  that  it  contains  many  iudifferent  mem- 
bers, who  are  not  inaptly  called  dead-wood.  This  is  the  kind  of  men 
who  are  never  willing  to  do  anything  but  share  in  the  success  which 
others  have  won,  and  administer  caustic  rebuke  in  the  event  of  fail- 
ure. Third,  it  was  unfortunate  in  this  regard,  to  have  a president 
of  whom  the  Fellows  knew  so  little.  Finally,  and  more  potent  as 
a reason  for  the  failure  of  the  scheme  than  all  the  foregoing,  was  the 
fact  that  the  Fellows  had  never  been  made  to  understand  that  each 
of  them  was  under  obligation  to  promote  the  welfare  of  the 
Academy. 

The  most  useful,  as  well  as  most  conspicuous  feature  of  the  plan 
proposed  is  the  inclusion  of  every  Fellow  in  the  proposed  work.  If 
all  the  labor  of  a society  is  performed  by  a few  members,  that  organi- 
zation contains  an  element  of  weakness  that  may  at  any  time  destroy 
it.  But  if  every  individual  composing  the  whole  makes  a regular 
contribution  to  its  support,  each  must  feel  an  interest  in  its  pros- 
perity, which  is  otherwise  impossible.  In  the  Academy  we  have  no 
annual  tax  of  money,  and,  after  paying  his  initiation  fee,  no  Fellow 
has  been  called  upon  for  any  services  which  he  could  consider 
obligatory,  unless  he  has  accepted  an  official  position.  Conse- 
quently, there  has  been  no  demand  upon  the  loyalty  or  energy  of 
the  members  generally,  and  it  is  not  wonderful  that  their  interest 
has  been  small.  If  they  had  been  asked  frequently  to  render  some 
aid  to  the  cause,  if  in  any  way  the  necessities  of  the  situation  had 
been  kept  before  them,  the  attempt  which  has  been  made  would 
have  been  crowned  with  success,  and  we  might  to-day  rejoice  in  a 
membership  of  two  or  three  thousand. 


18 


A COMMITTEE  ON  INCREASE  OF  FELLOWSHIP  NEEDED. 

The  experience  of  the  past  should  guide  our  future  conduct.  I 
suggest,  therefore,  that  a committee  of  three  Fellows  who  are  widely 
and  favorably  known,  energetic  and  willing  to  give  hard  work  to 
the  cause,  be  appointed,  with  instructions  to  procure  the  address  of 
each  physician  in  the  United  States  who  is  eligible  to  fellowship 
under  our  rules ; to  ascertain  his  standing ; to  furnish  him,  if 
worthy,  with  a historical  sketch  of  the  Academy,  a list  of  its  Fel- 
lows, a brief  statement  of  its  purposes  and  principles,  and  an  invi- 
tation to  enter  it.  The  Fellow  from  whom  favorable  information  is 
obtained  will  stand  as  the  candidate’s  sponsor.  I feel  a good  deal 
of  confidence  that  our  numbers  could  be  trebled,  perhaps  quad- 
rupled, by  this  system  in  one  year.  I recommend  the  appropriation 
of  $200  to  defray  the  expenses  of  this  committee. 

Not  only  does  the  Academy  need  a large  increase  in  numbers, 
but  means  should  be  taken  to  arouse  the  flagging  enthusiasm  of  the 
Fellows.  Many  who  do  not  know  much  about  our  society  would 
be  gratified  and  awakened  by  full  information  concerning  it.  To 
this  end  I make  several  suggestions: — 

A CATALOGUE  OF  THE  FELLOWS  DEMANDED. 

A need  which  has  been  often  felt  is  a catalogue  of  our  Fellows. 
Once,  at  least,  it  was  thought  to  have  been  provided  for  ; but  noth- 
ing came  of  the  attempt.  I advise,  therefore,  the  appointment  of  a 
committee  of  three  Fellows,  instructed  to  prepare  and  publish  a 
catalogue  of  the  Academy,  containing  the  following  data  concern- 
ing each  living  Fellow  or  Honorary  Member ; his  name  in  full  ; 
post-office  address;  collegiate  degrees  received,  with  date  of  each, 
and  name  of  institution  conferring  them  ; official  positions  of  im- 
portance held  by  him,  such  as  professorships,  physiciancies  or  sur- 
geoncies to  hospitals,  membership  in  state  boards  of  health,  princi- 
pal offices  in  important  societies ; high  political  appointments  ; the 
titles  of  three  volumes,  and  of  three  pamphlets  or  articles  of  which 
he  is  the  author.  The  catalogue  should  also  contain  the  name  of 
each  deceased  Fellow  and  Honorary  Member,  and  of  his  last  place 
of  residence,  the  date  and  place  of  his  death,  his  age  and  the  data 
concerning  his  degrees,  positions  and  writings  which  would  be  pre- 
sented if  he  were  still  living.  A copy  of  this  catalogue  should  be 
sent  to  each  Fellow,  to  every  respectable  medical  journal,  and  to 


19 


every  public  medical  library  iu  the  country.  One  hundred  copies 
more  than  are  needed  for  these  purposes  should  be  printed,  and 
sold  to  parties  wishing  to  purchase  them.  A sum  not  exceeding 
two  hundred  and  fifty  dollars  should  be  appropriated  for  the  ex- 
penses of  this  committee. 

THE  TRANSACTIONS  SHOULD  BE  PUBLISHED. 

The  by-laws  provide  that  the  council  of  the  Academy  shall 
“ decide  upon  and  superintend  all  its  publications,”  and  that  the 
secretary  “ shall  edit  the  transactions  in  the  manner  and  style  agreed 
upon  by  the  council.”  Hitherto  the  president’s  address  has  usually 
been  published  in  pamphlet  form,  and  distributed  to  the  Fellows, 
and  a very  few  other  papers  have  been  thus  honored  ; but  “ the 
transactions  ” referred  to  in  the  by-laws  have  not  been  issued.  It 
would  seem  that  the  time  has  come  for  action  in  the  premises.  The 
whole  business  is  in  the  control  of  the  council ; but  that  committee 
will  unquestionably  receive  with  pleasure  an  expression  of  the 
wishes  of  the  Academy.  It  would  be  wise  for  the  council  to  select 
for  publication  such  of  this  year’s  essays  as  seem  worthy  of  this 
distinction,  ascertain  the  cost  of  printing  and  binding  five  hundred 
copies,  and  the  number  of  these  which  would  be  purchased  at  cost 
by  the  Fellows.  If  the  demand  should  warrant  the  attempt,  the 
business  could  be  undertaken  with  no  chance  of  burdening  our 
treasury,  and  with  a most  beneficial  effect  upon  the  reputation  of 
our  society. 

THE  PRICE  OF  THE  PARCHMENT  DIPLOMA. 

A few  years  after  the  founding  of  the  Academy,  a Latin  cer- 
tificate of  membership  was  prepared  and  engraved.  The  price  of 
this  certificate,  printed  on  parchment,  is  fixed  by  the  constitution  at 
ten  dollars,  a sum  so  large  as  to  be  almost  prohibitory.  Only  fifty- 
one  copies  have  been  sold.  The  plate  was  paid  for  long  ago,  and 
there  appears  to  be  no  good  reason  for  continuing  a policy  which 
practically  deprives  most  of  our  members  of  an  official  certificate  of 
fellowship,  worthy  of  the  dignity  of  the  organization.  I,  therefore, 
propose  a change  in  the  constitution,  reducing  the  sum  to  be  paid 
for  these  diplomas  to  cost,  which,  at  present  rates,  would  not  exceed 
two  dollars  each.  Very  soon  after  the  passage  of  this  amendment, 
there  will  be  a brisk  demand  for  these  parchments,  and  our  society 


20 


will  be  brought  prominently  to  the  attention  of  thousands  who  have 
never  heard  of  it  before.  Let  us  hope  that  the  time  is  not  far  dis- 
tant when  the  Academy  shall  be  so  prosperous  that  the  admission 
fee  can  safely  be  raised  to  a price  which  shall  enable  it  to  issue  a 
diploma  to  every  Fellow  on  admission,  without  additional  charge. 

A COMMITTEE  TO  PROCURE  ESSAYS  REQUIRED. 

It  is  not  a small  task  to  procure  essayists  for  our  meetings.  Our 
Fellows  are  busy  men,  most  being  actively  engaged  in  practice,  and 
very  many  being  teachers  in  colleges,  physicians  and  surgeons  in 
hospitals,  editors,  authors,  and  frequent  contributors  to  medical 
societies;  and  very  few  voluntarily  offer  papers  to  the  Academy. 
To  illustrate  the  labor  of  providing  acceptable  entertainment  for  a 
meeting,  it  may  be  remarked  that  the  present  programme  is  the 
result  of  nearly  fifty  urgent  invitations  by  the  president,  and  a large 
number  by  the  secretary.  I suggest  that  a special  committee  be 
charged  with  this  duty  for  the  ensuing  year. 

The  initial  meeting  of  the  Congress  of  American  Physicians  and 
Surgeons  was  held  in  the  city  of  Washington  this  year,  and  the 
success  of  the  venture  was  sufficient  to  make  it  probable  that  a 
similar  gathering  will  take  place  hereafter  triennially.  It  is  advis- 
able for  the  Academy  to  consider  the  expediency  of  associating 
itself  with  the  other  societies  composing  the  Congress,  and  thus 
bringing  itself  into  more  prominent  notice  than  it  has  hitherto 
enjoyed. 

PROPOSED  AMENDMENTS  TO  THE  CONSTITUTION  DISCUSSED. 

At  our  last  meeting  in  this  city,  seven  amendments  to  the  consti- 
tution were  proposed  by  six  different  Fellows.  These  were  laid 
over  without  decisive  action  at  Pittsburgh,  and  again  at  Washington, 
and  now  they  present  themselves  anew  for  your  consideration. 
They  naturally  are  arranged  in  two  distinct  groups,  six  being  in  one, 
and  one  in  the  other.  Those  of  the  first  set  relate  to  membership. 
It  is  pertinent  for  me  to  mention  them,  and  offer  my  comments, 
which  I do  with  sincere  appreciation  of  the  loyalty  of  the  proposers, 
and  most  hearty  regret  at  being  constrained  to  differ  with  them  on 
points  which  they  have  much  at  heart,  and  firmly  believe  to  be 
importaut  for  the  welfare  of  the  Academy. 

Dr.  Sibbet  wishes  to  have  a provision  for  “corresponding  mem- 


21 


bers,”  who  shall  be  distinguished  medical  men  in  foreign  lands.  I 
would  prefer  to  delay  this  movement  until  we  shall  be  able  to  com- 
municate to  such  gentlemen  as  shall  be  interested  to  correspond 
with  us  tidings  concerning  medical  education  in  America  of  a kind 
more  creditable  to  our  own  land. 

B.  S.  OR  PH.  B.  EQUIVALENT  TO  A.  B. 

Dr.  Sibbet  also  proposes  that  “ candidates  having  other  literai’y 
degrees  than  Bachelor  of  Arts  or  Master  of  Arts  may  be  elected  as 
Fellows,  provided  they  shall  not  exceed  five  percentum  of  the  whole 
number;  and  provided,  also,  that  they  shall  have  contributed  to 
the  literature  of  the  profession.”  For  instance,  a gentleman  who  is 
not  a college  alumnus,  but  has  received  an  honorary  degree  of  Doctor 
of  Philosophy,  might  be  admitted  under  this  rule;  whereas,  an 
equally  well-educated  physician,  who  has  no  literary  degree  except 
an  honorary  A M.,  cannot  enter.  This  may  not  be  what  is  intended, 
but  the  rule  would  be  easily  capable  of  the  construction  which  I 
have  put  upon  it. 

It  is  clear  to  my  mind  that  we  are  not  acting  with  entire  consist- 
ency in  excluding  those,  who,  instead  of  the  degree  of  Bachelor  of 
Arts,  have  taken  that  of  Bachelor  of  Science  or  Bachelor  of  Phi- 
losophy. One  would  expect  us  to  put  the  two  on  the  same  footing, 
judging  from  the  words  of  our  constitution,  which  says: 

“The  objects  of  the  Academy  shall  be  (1)  to  bring  those  who  are 
Alumni  of  Classical,  Scientific  and  Medical  schools  into  closer  rela- 
tions with  each  other;  (2)  to  encourage  young  men  to  pursue  regu- 
lar courses  of  study  in  Classical  and  Scientific  institutions  before 
entering  upon  the  study  of  medicine.”  In  mauy  colleges  the  stu- 
dents in  the  same  class,  while  pursuing  identical  lines  in  most 
respects,  follow  diverging  lines  in  others.  The  drill  is  equally 
severe,  the  mental  discipline  probably  as  great  in  one  as  in  the 
other ; but,  because  one  group  has  chosen  to  pay  particular  attention 
to  the  humanities,  and  the  other  has  selected  a curriculum  in  which 
the  natural  sciences  have  had  a more  prominent  place,  the  degree 
in  arts  is  conferred  on  the  one,  and  that  in  science  on  the  other. 
The  A.  B.  and  the  B.  S.  are  intended  to  balance  in  the  academic 
scales.  On  what  ground  do  we  decide  the  one  to  be  evidence  of  a 
good  education,  and  ignore  the  four  years  of  studious  application 
which  is  represented  by  the  others?  Suppose  that  a young  man  has 


22 


looked  forward  to  our  fellowship  as  a coveted  honor,  and  decides  on 
the  strength  of  our  counsel  in  Article  II  of  the  constitution  to  take 
a regular  preparatory  course.  His  tastes  lead  him  toward  the 
physical  sciences  rather  than  to  the  classics,  and  without  noticing 
the  restrictions  in  Article  III,  he  follows  the  plan  which  ends  in  the 
B.  S.  degree.  He  is  as  able,  as  well  furnished  mentally,  as  upright 
as  his  brother,  who  is  A.  B.  But,  after  the  two  have  become  doc- 
tors of  medicine,  the  latter  can  enjoy  our  association,  and  the  former 
is  excluded.  Would  he  not  feel  an  excusable  bitterness  at  our 
treatment  of  him  ? 

I hold  in  my  hand  an  application  from  a physician  who  has  been 
engaged  in  practice  eleven  years,  is  a Bachelor  of  Science  and  a 
Doctor  of  Philosophy.  His  sponsor,  knowing  him  to  be  college-bred, 
thought  that  he  was  a Bachelor  of  Arts ; but  learning  the  fact, 
writes,  “ If  any  discretion  is  allowed,  I would  strongly  recommend 
his  admission.”  It  seems  to  me  that  the  interests  of  the  Academy 
would  not  suffer  by  recognizing  B.  S.  and  Ph.  B.  as  the  equals  of 
A.  B.,  provided  that  they  have  been  obtained  after  a regular  four 
years’  course.  But  an  amendment  must  be  differently  worded  from 
that  under  discussion  in  order  to  effect  this  result. 

Dr.  Gihon  would  admit  “ graduates  in  medicine,  who,  having  no 
degree  in  letters  received  in  course,  have  distinguished  themselves 
in  medicine  and  collateral  sciences.”  Literally  interpreted,  this 
rule  would  open  the  door  to  no  dangerously  large  number  ; for, 
while  many  who  have  no  literary  degree  distinguish  themselves  in 
medicine,  very  few  become  noted  for  their  learning  in  collateral 
sciences  also.  But,  substituting  “ or  ” for  “ and,”  will  it  not  be 
better  to  leave  this  matter  as  it  is,  until  we  have  gathered  in  all  the 
good  men  possible  under  our  existing  rule? 

Dr.  Bush  would  give  the  council  power  to  nominate  for  fellow- 
ship any  honorable  physician,  who  has  distinguished  himself  by  the 
production  of  any  valuable  publication.  On  this  proposition  the 
same  criticism  is  offered  as  on  the  preceding. 

Dr.  Edward  Jackson  would  have  for  each  candidate  thi'ee  spon- 
sors, who  should  write  out  a statement  of  his  fitness.  After  a year’s 
deliberation  the  council  may  report  on  the  case,  and  the  society 
may  elect.  At  a time  like  the  present,  when  the  chief  need  of  the 
Academy  seems  to  be  a large  increase  of  members,  it  would  hardly 
be  politic  to  make  admission  more  difficult  than  it  is  now.  The 


23 


Academy  probably  has  enough  confidence  in  the  discretion  of  its 
Fellows,  to  take  the  approval  of  any  one  of  them  as  abundant  testi- 
mony to  the  fitness  of  a candidate. 

Dr.  Mclntire  would  have  the  election  of  an  applicant  delayed  a 
year  after  the  approving  report  of  the  council  is  made.  This  would 
be  a safeguard  against  the  introduction  of  undesirable  persons; 
but  the  year  of  waiting  would  be  unnecessarily  annoying  to -the  can- 
didate, because  the  same  advantage  would  be  gained  by  the  simple 
device  of  having  each  Fellow  supplied  with  a list  of  applicants  a 
short  time  before  the  annual  meeting.  Then,  if  any  Fellow  wished 
to  object  to  the  admission  of  any  one  whose  name  was  thus  pre- 
sented, he  could  readily  do  so  by  letter  or  in  person.  This  method 
works  admirably  in  the  Maine  Medical  Association,  in  which  it  has 
long  been  in  operation. 

DOES  THE  ACADEMY  NEED  A CODE  OF  ETHICS? 

The  sole  proposal  of  the  second  set  relates  to  an  utterly  different 
subject.  Dr.  Sutton,  one  of  our  charter  members,  and  but  recently 
our  president,  advocates  a change  in  Article  VIII,  Section  I.  At 
present  the  paragraph  runs  thus:  “The  Fellows  of  the  Academy, 

in  their  relations  with  each  other  and  with  their  fellow-men,  agree 
to  be  governed  by  the  principles  embodied  in  the  present  code  of 
ethics  of  the  American  Medical  Association,  and  by  the  constitution 
and  by-laws  of  the  Academy.”  Dr.  Sutton  desires  to  have  this 
amended  to  read  as  follows  : “ The  Fellows  of  the  Academy  will 

be  governed  by  those  principles  which  actuate  educated,  cultured 
and  honorable  men  in  every  profession,  and  by  the  Constitution 
and  By-laws  of  the  Academy.” 

To  this  proposition  I trust  that  the  society  will  give  its  most 
serious  and  judicial  meditation.  For  my  own  part,  I have  no  objec- 
tion to  the  principles  embodied  in  the  Code  of  the  American  Medi- 
cal Association.  The  expression  of  them  seems  to  me  to  be  not 
altogether  felicitous;  but,  if  I understand  them,  they  are  worthy 
of  approval.  During  the  uuhappy  controversy  over  the  Code  in 
this  State  several  years  ago,  my  sympathies  were  with  the  old  code 
men.  It  would  be  only  harmful  now  to  revive  in  detail  the  memo- 
ries of  that  extremely  unfortunate  episode.  Nobody  on  either  side 
would  wish  to  renew  the  discussion,  with  its  attendant  circumstances 
of  ill-feeling  and  hostile  exhibitions.  But  though  I entertain  no 


24 


desire  to  have  my  State  Medical  Association  abolish  its  Code,  which 
is  that  of  the  national  society,  I believe  that  the  Academy  will  act 
wisely  if  it  adopts  the  alteration  under  consideration.  If  we  had 
no  Code,  it  would  not  occur  to  us  that  one  was  needed.  We  are 
here  not  as  therapeutists,  but  as  reformers.  If  we  discard  all  allu- 
sions to  codes,  we  shall  be  in  no  peril  of  an  invasion  of  wicked  or 
crazy  irregulars ; for  no  candidate’s  application  can  be  considered 
without  the  approving  signature  of  a Fellow  in  good  standing.  We 
need  have  no  suspicion  that  the  proposer  of  the  alteration  is  plot- 
ting to  obtain  our  sanction  in  advance  to  orgies  of  unholy  consulta- 
tions. But  more  important  than  these  thoughts  is  the  fact,  encoun- 
tered by  more  than  one  of  us  in  his  search  for  applicants,  that  the 
presence  in  our  Constitution  of  the  paragraph  under  discussion  is  an 
obstacle  of  the  gravest  nature  in  the  way  of  an  increase  in  our 
numbers.  The  objection  does  not  come  from  the  weak  and  whimsi- 
cal, but  from  strong,  high-minded  thinkers.  Many  have  been 
offended  by  what  they  consider  the  unjust  and  tyrannical  conduct 
of  the  American  Medical  Association,  and  shun  membership  in  any 
society  which  even  seems  to  be  a satellite  of  it.  After  three  years 
in  which  to  ponder  on  the  subject,  I have  fully  decided  that  the 
adoption  of  this  amendment  is  consistent  with  the  strict,  orthodox 
principles  of  medical  ethics  in  which  I was  reared,  and  is  for  the 
best  interests  of  the  Academy. 

THE  ADMISSION  OF  WOMEN. 

Never  before  has  it  been  appropriate  to  address  the  Academy  as 
“ Ladies  and  Gentlemen  but  to-day  it  is  my  privilege  to  use  this 
significant  expression.  You  have  accepted  as  Fellows  a number  of 
women,  and  henceforth  we  who  have  labored  in  this  society  for  the 
advancement  of  medical  education  are  to  have  the  cooperation  of 
the  sex,  long  excluded  from  medical  associations,  but  now  admitted 
on  an  equal  footing  with  men  in  some  of  the  foremost  of  our  pro- 
fessional organizations.  It  is  indicative  of  a marked  change  of 
sentiment  and  opinion  that  bodies  as  conservative  as  the  Massachu- 
setts Medical  Society  and  the  Philadelphia  County  Medical  Society 
have  opened  their  doors  to  all,  without  reference  to  sex,  who  have 
the  requisite  ability  and  training.  It  is  not  creditable  to  our  coun- 
try, or  in  keeping  with  the  liberality  which  theoretically  character- 
izes our  institutions,  that  a discrimination  should  so  long  have  been 


25 


made  against  women  in  scientific  associations.  But  considerations 
of  justice  have  at  last  prevailed  so  generally  that,  at  the  present 
time,  the  opposition  to  educated  physicians  on-  account  of  sex  is 
feeble,  compared  to  the  violent  antagonism  which  formerly  existed. 
The  stock  arguments  that  women  have  not  the  physical  strength  to 
sustain  them  in  the  trials  of  practice,  that  they  lack  the  intellectual 
capacity  and  the  moral  force  which  we  deem  essential,  have  ceased 
to  have  weight.  Facts,  easily  observed,  prove  the  contrary.  There 
are  too  many  women  practicing  medicine  scientifically,  skillfully,  suc- 
cessfully, and  without  injury  to  their  health,  to  permit  such  objections 
to  influence  any  one  who  is  well  informed.  Having  been  the  medical 
teacher  of  many  women,  and  having  watched  the  careers  of  a con- 
siderable number  with  peculiar  interest  and  satisfaction,  I feel  fully 
justified  in  the  prediction  that  the  Academy  will  be  strengthened  by 
the  admission  of  the  gentlewomen  who  have  entered  to-day,  and 
will  never  regret  this  departure  from  its  former  usages. 

It  is  noteworthy  that  some  of  the  staunchest  upholders  of  a strict 
preliminary  examination,  as  ascertained  by  the  detective  work  of 
our  committee  on  the  subject  last  year,  were  the  schools  managed 
by  women.  They  had  advanced  their  standard  because  they  saw 
the  necessity  for  reform,  and  they  adhered  honestly  to  their  pub- 
lished rules,  as  so  many  of  the  schools  for  men  did  not.  The  pro- 
portion of  those  which  stood  by  their  colors  was  much  greater 
among  the  women  than  among  the  men. 

It  is  simply  justice  to  the  Academy  to  state  that  it  has  never  ob- 
jected to  the  admission  of  women.  This  year  is  the  first  in  which 
women  have  applied  for  fellowship. 

EMINENT  DECEASED  FELLOWS. 

Since  our  last  meeting  the  grave  has  closed  over  several  of  our 
associates.  Of  these  the  most  distinguished  was  Cornelius  Rea 
Agnew,  whose  sudden  death  shocked  the  community  and  left  a void 
so  great  that  it  will  not  cease  to  be  felt  as  long  as  any  survive  who 
knew  him.  His  splendid  natural  endowments,  his  admirable  devel- 
opment, his  great  achievements,  his  moral  elevation,  have  all  been 
the  subjects  of  eloquent  eulogies  so  recently,  that  further  mention 
of  them  is  superfluous  here. 

It  would  be  unjust  to  my  feelings,  were  this  occasion  to  be  allowed 
to  pass  without  my  paying  a tribute  to  the  memory  of  one  of 


26 


our  lost  companions  whom  I knew  most  intimately,  Edward  Swift 
Dunster.  He  was  still  a young  man  when  I first  became  acquainted 
with  him,  but  he  had  already  made  an  enviable  reputation  as  a 
writer  and  lecturer.  We  were  associated  for  two  years  in  the  faculty 
of  a large  medical  school,  and,  from  sympathy  of  tastes  and  commu- 
nity of  interests,  we  were  much  together.  He  honored  me  with 
his  friendship,  and  the  memory  of  it  remaius  with  me  like  a pre- 
cious benediction.  His  varied  and  accurate  learning,  his  scholarly 
instincts,  his  choice  and  elegant  diction,  and  ready  wit  combined  to 
make  him  a most  entertaining  companion  and  a teacher  of  unusual 
brilliancy  and  power.  But  though  he  won  my  admiration  for  these 
attractive  attributes,  I chiefly  delight  to  think  of  him  as  a bold  and 
tireless  advocate  of  the  principles  for  which  the  Academy  contends. 
Early  and  late  he  struggled  with  the  prejudices,  the  indifference,  the 
stolid  and  unteachable  conservatism,  which  those  who  should  have 
aided  him  threw  continually  in  his  way  ; and  just  when  the  path  began 
to  be  clearer,  and  hope  was  strengthening  into  expectation,  the  fatal 
summons  came,  and  the  task  which  he  had  set  himself  was  left 
unfinished.  His  death  is  a distinct  and  irreparable  loss  to  the  cause 
of  sound  medical  education.  His  vacant  place  should  be  a continual 
reminder  of  the  work  which  still  remains  to  be  done,  and  should 
stimulate  us  to  renewed  exertions. 

IN  CONCLUSION. 

In  obedience  to  our  rules,  I have  written  this  address.  I have  not 
attempted  an  oration,  for  my  conception  of  my  duty  compelled  the 
belief  that  the  required  paper  should  be  of  a business  character. 
Consequently,  avoiding  rhetorical  horticulture,  I have  given  an 
account  of  my  stewardship,  and  have  expressed  my  views  of  the 
functions  of  the  Academy,  and  of  the  best  methods  to  pursue  in 
order  to  compass  the  desired  results. 

A year  ago,  when  you  paid  me  the  compliment  of  elevation  to 
the  presidency,  my  surprise  at  the  altogether  unsought  and  un- 
anticipated election  prevented  an  adequate  and  seemly  acknowledg- 
ment of  your  partiality.  I could  merely  stammer  my  thanks 
and  a promise  to  do  my  best  to  promote  the  interests  of  the 
Academy.  My  term  of  service  closes  at  this  meetiug ; and,  as  I 
look  back  upon  it,  I find  that  the  hopes,  which  seemed  at  first  to 
be  easy  of  realization,  have  been  but  imperfectly  fulfilled.  But  I 


27 


have  no  broken  promise  to  regret,  for  I have  really  done  what  I 
could  for  the  Academy. 

I am  fully  persuaded  that  less  harm  per  year  would  ensue  from 
the  absolute  cessation  of  all  progress  in  medical  discovery  and 
invention,  than  now  results  from  the  low  standard  of  preliminary 
and  technical  education.  I believe,  too,  that  our  cause  needs  coura- 
geous, persistent  and  aggressive  action.  Holding  these  opinions,  the 
labor  which  I have  done  has  been  the  practical  expression  of  a con- 
viction of  duty.  And  my  only  grief  in  contemplation  of  the  result 
is  that  my  best  has  been  so  poor. 


*0 


S. 


I 


/ 


